9.H. Workshop: Understanding the institutional context of health inequalities. A life stage approach

Abstract Background The health of young people is strongly linked to their socioeconomic background. However, there is little systematic research on the complex mechanisms underlying the association between family socioeconomic position and health among young people, particularly regarding contextual factors at the (intermediate) meso-level. Several institutional contexts are relevant for young people's lives: the family, kindergarten, primary and secondary school, higher education system, vocational school and training, workplace and the healthcare system. Previous studies demonstrated that characteristics of these institutional contexts are associated with young people's health and well-being. It is unclear, which role they play regarding health inequalities. The aim of the workshop is to analyse the role of institutional characteristics, such as compositional (which people are found in an institution) and contextual (the structural characteristics of an institution) factors for the development or existing health inequalities. Methods The research unit FOR2723 analyses the role of meso-level, institutional characteristics regarding health inequalities considering the whole period of early life based a common conceptual framework. The results are based on empirical analyses of various secondary data, such as the National Educational Panel Study (NEPS) or the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bodymass index (BMI) and the subjective self-assessment of health are considered as outcomes. Results We found substantial social inequalities in health and health behaviour at any life stage investigated. In each life stage we found meso-level characteristics of the family (family investment, family stress, family atmosphere, and parental health behaviour and well-being), the kindergarten (the association between ECEC centre focus and family SEP on pre-school children's BMI), the school (composition of the school in terms of education, income, and occupational prestige of the students’ parents), the institutions and labour market states involved in the school-to-work transition (vocational training places, universities, workplaces, unemployment spells) as well as the health care system (regional health policy), which are associated with social inequalities in young people's self-rated health, subjective well-being and BMI. Discussion In addition to micro-level determinants, meso-level characteristics of important institutions that young people are exposed to (family, kindergarten, school, school-to-work-transitions, healthcare system) are relevant for their health and reinforce health inequalities. More research is needed to understand how institutional contexts contribute to health inequalities and which institutional changes are needed to reduce inequalities. Key messages • The role of institutional characteristics, such as compositional and contextual factors for health inequalities is unclear. • Meso-level characteristics of institutions in young people (family, kindergarten, school, school-to-work-transitions, healthcare system) are relevant for their health and reinforce health inequalities.


Background:
The health of young people is strongly linked to their socioeconomic background. However, there is little systematic research on the complex mechanisms underlying the association between family socioeconomic position and health among young people, particularly regarding contextual factors at the (intermediate) meso-level. Several institutional contexts are relevant for young people's lives: the family, kindergarten, primary and secondary school, higher education system, vocational school and training, workplace and the healthcare system. Previous studies demonstrated that characteristics of these institutional contexts are associated with young people's health and well-being. It is unclear, which role they play regarding health inequalities. The aim of the workshop is to analyse the role of institutional characteristics, such as compositional (which people are found in an institution) and contextual (the structural characteristics of an institution) factors for the development or existing health inequalities.

Methods:
The research unit FOR2723 analyses the role of meso-level, institutional characteristics regarding health inequalities considering the whole period of early life based a common conceptual framework. The results are based on empirical analyses of various secondary data, such as the National Educational Panel Study (NEPS) or the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bodymass index (BMI) and the subjective self-assessment of health are considered as outcomes.

Results:
We found substantial social inequalities in health and health behaviour at any life stage investigated. In each life stage we found meso-level characteristics of the family (family investment, family stress, family atmosphere, and parental health behaviour and well-being), the kindergarten (the association between ECEC centre focus and family SEP on pre-school children's BMI), the school (composition of the school in terms of education, income, and occupational prestige of the students' parents), the institutions and labour market states involved in the school-to-work transition (vocational training places, universities, workplaces, unemployment spells) as well as the health care system (regional health policy), which are associated with social inequalities in young people's self-rated health, subjective well-being and BMI. Discussion: In addition to micro-level determinants, meso-level characteristics of important institutions that young people are exposed to (family, kindergarten, school, school-to-work-transitions, healthcare system) are relevant for their health and reinforce health inequalities. More research is needed to understand how institutional contexts contribute to health inequalities and which institutional changes are needed to reduce inequalities. Key messages: The role of institutional characteristics, such as compositional and contextual factors for health inequalities is unclear.
Meso-level characteristics of institutions in young people (family, kindergarten, school, school-to-work-transitions, healthcare system) are relevant for their health and reinforce health inequalities.
Abstract citation ID: ckac129.580 Socioeconomic position and self-rated health among adolescents: the mediating role of the family

Background:
Although health inequalities in adolescence are well documented, the underlying mechanisms remain unclear. Few studies have examined the role of the family in explaining adolescents' health inequalities. The study aimed to explore whether the association between socioeconomic position and self-rated health (SRH) was mediated by familial determinants.

Methods:
Using data from wave 2 of the KiGGS study (1,838 female and 1,718 male 11-to 17-year-olds), linear regression analyses were conducted to decompose the total effects of parents' education, occupation, income, socioeconomic position index, and adolescents' subjective social status on SRH into direct effects and indirect effects through familial determinants (family cohesion, parenting styles, parental well-being, stress, obesity, smoking and sporting activity).

Results:
A significant total effect of all socioeconomic position indicators on SRH was found, except for income in male adolescents. In female adolescents, more than 70% of the total effects of each socioeconomic position indicator were explained by familial mediators, whereas no significant direct effects remained. The most important mediator was parental well-being, followed by family cohesion, parental smoking and sporting activity. In male adolescents, the associations of parental education, the socioeconomic position index and subjective social status with SRH were also mediated by familial determinants (family cohesion, parental smoking and obesity). However, a significant direct effect of subjective social status remained.

Conclusions:
The family appears to play an important role in explaining health inequalities, particularly in female adolescents. Reducing health inequalities in adolescence requires policy interventions, community-based strategies, as well as programs to improve parenting and family functioning.